Objective: Food interferes with gastrointestinal absorption of levodopa which requires spacing with meals. This study aimed to evaluate the effect pictographs on Levodopa packaging Fig 1 on increasing patient compliance with meals -Levodopa spacing.

Background: Levodopa is relatively inexpensive and the most effective drug in Parkinson’s disease.But clinical efficacy and plasma levels are affected by food intake. Accompanied by meals delay and decrease the absorption from gut ¹. However in a previous study², only 30% patients had been advised meal-L-Dopa spacing by their physicians and even in those advised spacing with meals , many patients were not following instructions correctly leading to decreased clinical response.

Method: 4 patients of Parkinson’s disease who were on Levodopa therapy with pictographs on Levodopa packaging prior to seeking consultation with our institution were evaluated.  We chose only those  patients to whom Levodopa-meal spacing had not been advised by their physicians to evaluate the effectiveness of packaging pictographs .Since only one levodopa brand was offering pictographs , we had to recruit patients only on that particular levodopa brand.

Results: 3 out of 4 patients had started spacing levodopa correctly with meals seeing the L-dopa packaging pictographs despite being not told by their physicians Table 1. However  2 of these 3 were still not spacing levodopa correctly with breakfast owing to misconceptions about taking drugs on an empty stomach in morning .Clinical responses improved after patients were advised correct spacing practices.

Conclusion: Pictographs on Levodopa packaging improve compliance of Levodopa/Carbidopa spacing with meals even in patients who had not been advised spacing by their physicians. Unfortunately only a single Levodopa brand was offering Pictographs on packaging and it also stopped giving the extra packaging with pictographs as it was causing an extra expenditure of Indian Rupees 1.90 [ 0.023 US dollars] per strip to the company. However since packaging pictographs improve Levodopa-meal spacing , regulatory authorities should make it mandatory for all levodopa brands . This , in addition to other measures, will ensure the most effective drug for Parkinson’s disease is utilised to its maximum potential.

References: 1. Nutt JG, Woodward WR, Carter JH, Trotman TL. Influence of fluctuations of plasma large neutral amino acids with normal diets on the clinical response to levodopa. J Neurol Neurosurg Psychiatry. 1989;52(4):481–7.
2. N. Sawal, K. Shukla. Awareness of Levodopa/Carbidopa spacing with meals in patients of Idiopathic Parkinson’s disease – Insights from an Indian Parkinson’s Registry [abstract]. Mov Disord. 2019; 34 (suppl 2).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effectiveness-of-use-of-pictographs-on-levodopa-packaging-to-ensure-awareness-of-levodopa-carbidopa-spacing-with-meals-in-patients-of-idiopathic-parkinsons-disease/